TY - JOUR T1 - Multiparametric Imaging of Tumor Hypoxia and Perfusion with <sup>18</sup>F-Fluoromisonidazole Dynamic PET in Head and Neck Cancer JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 1072 LP - 1080 DO - 10.2967/jnumed.116.188649 VL - 58 IS - 7 AU - Milan Grkovski AU - Heiko Schöder AU - Nancy Y. Lee AU - Sean D. Carlin AU - Bradley J. Beattie AU - Nadeem Riaz AU - Jonathan E. Leeman AU - Joseph A. O’Donoghue AU - John L. Humm Y1 - 2017/07/01 UR - http://jnm.snmjournals.org/content/58/7/1072.abstract N2 - Tumor hypoxia and perfusion are independent prognostic indicators of patient outcome. We developed the methodology for and investigated the utility of multiparametric imaging of tumor hypoxia and perfusion with 18F-fluoromisonidazole (18F-FMISO) dynamic PET (dPET) in head and neck cancer. Methods: One hundred twenty head and neck cancer patients underwent 0- to 30-min 18F-FMISO dPET in a customized immobilization mask, followed by 10-min static acquisitions starting at 93 ± 6 and 160 ± 13 min after injection. A total of 248 lesions (≥2 cm3) were analyzed. Voxelwise pharmacokinetic modeling was conducted using an irreversible 1-plasma 2-tissue-compartment model to calculate surrogate biomarkers of tumor hypoxia (k3), perfusion (K1), and 18F-FMISO distribution volume. The analysis was repeated with truncated dPET datasets. Results: Substantial inter- and intratumor heterogeneity was observed for all investigated metrics. Equilibration between the blood and unbound 18F-FMISO was rapid in all tumors. 18F-FMISO distribution volume deviated from the expected value of unity, causing discrepancy between k3 maps and total 18F-FMISO uptake and reducing the dynamic range of total 18F-FMISO uptake for quantifying the degree of hypoxia. Both positive and negative trends between hypoxia and perfusion were observed in individual lesions. All investigated metrics were reproducible when calculated from a truncated 20-min dataset. Conclusion: 18F-FMISO dPET provides the data necessary to generate parametric maps of tumor hypoxia, perfusion, and radiotracer distribution volume. These data clarify the ambiguity in interpreting 18F-FMISO uptake and improve the characterization of lesions. We show total acquisition times can be reduced to 20 min, facilitating the translation of 18F-FMISO dPET into the clinic. ER -